Mitral Regurgitation

Question 1

Etiology of Acute MR

Answer 1

Rupture of tendinous cords
Rupture of papillary muscle
Perforation of leaflet
Endocarditis

Question 2

Etiology of Chronic MR

Answer 2

Mitral leaflet prolapse
CAD
Papillary muscle dysfunction

Question 3

Symptoms of MR

Answer 3

1. Pulmonary congestion and edema
2. Fatigue
3. A-fib and thromboembolism
4. Eccentric hypertrophy of LV
5. RV hypertrophy

Question 4

Complications of MR

Answer 4

Increased pressure in LA

LV end diastolic pressure is increased

Question 5

Physical Exam findings of an MR pt?

Answer 5

1. Sharp carotid upstroke when LV function is preserved
2. PMI is displaced to the left
3. Decreased S1, Wide splitting of S2 and S3
4. Pansystolic murmur starting with S1 and obscuring S2

Question 6

EKG findings of MR pt?

Answer 6

LAE, A-fib, LVH

Question 7

Chest x-ray findings of MR pt?

Answer 7

LAE, LVE, congestion

Question 8

Which MR pts need surgery?

Answer 8

1. Acute severe MR with symptoms warrants surgery

2. Chronic MR in symptomatic pts with EF <30% warrants surgery

Question 9

How are MR pts treated phramcologically?

Answer 9

1. Diuretics, Digoxin and salt restriction

2. Afterload reduction using Nitroprusside, ACEI, hydralazine